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Neurorehabilitation is a complex medical process which aims to aid recovery from a nervous system injury, and to minimize and/or compensate for any functional alterations resulting from it. [1] [2]
In case of a serious disability, such as caused by a severe spinal injury or brain damage, the patient and their families' abilities, life style, and projects, are suddenly shattered. In order to cope with this situation, the person and their family must establish and negotiate a "new way of living", both with their changed body and as a changed individual within their wider community.
Thus, neurorehabilitation works with the skills and attitudes of the disabled person and their family and friends. It promotes their skills to work at the highest level of independence possible for them. It also encourages them to rebuild self-esteem and a positive mood. Thus, they can adapt to the new situation and become empowered for successful and committed community reintegration. Neurorehabilitation should be:
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By focusing on all aspects of a person's functional independence and well-being, neurorehabilitation offers a series of therapies from the Medications, Physiotherapy, speech and swallow therapy, psychological therapies, occupational therapies, teaching or re-training patients on mobility skills, communication processes, and other aspects of that person's daily routine. [7] Neurorehabilitation also provides focuses on nutrition, psychological, and creative parts of a person's recovery.
Many neurorehabilitation programs, whether offered by hospitals or at private, specialized clinics, have a wide variety of specialists in many different fields to provide the most well rounded treatment of patients. These treatments, over a period of time, and often over the lifetime of a person, allow that individual and that person's family to live the most normal, independent life possible.
While the field of neurorehabilitation is relatively new, many therapies are controversial, and while some are considered cutting-edge technology, there may be little research to support whether or not helpful progress is the result. Neurorehabilitation is the culmination of many different fields to provide the best care and education for patients with injuries or diseases affecting their nervous system.
The most important therapies are those that help people live their everyday lives. These include physiotherapy, occupational therapy, rehabilitation psychology, speech and swallow therapy, vision therapy, and language therapy, and therapies focused on daily function and community re-integration. A particular focus is given to improving mobility and strength, as this is key to a person's independence.
Neurorehabilitation is a team work. The specialists who participate include: physiatrist or rehabilitation medicine specialist, neurologist, neurosurgeon, other medical specialists, physiotherapists, occupational therapists, respiratory therapists, prothetist and orthotist, rehabilitation nurse, psychologists, and vocational counselor. Physiotherapy includes helping patients recover the ability of physical actions which includes: balance retraining, gait analysis and transfer training, neuromuscular retraining, orthotics consultations, and aqua therapy. Occupational therapy helps patients in activities of daily living. Some of these include: home modifications and safety training (Fall prevention strategies), cognitive rehabilitation – retraining for memory, attention, processing, and executive functions. It may also include neuro-muscular strengthening and training, and visual perceptual skill development. Rehabilitation psychologists and speech–language pathologists and have begun to provide cognitive rehabilitation as well with goals that emphasize instruction in life-changes that facilitate increased independence. Speech and language therapy includes assisting patients with swallowing and communication issues. Rehabilitation psychology includes helping patients deal with their changed, often dramatically so, circumstances especially coping to a changed identity of self as a result of adaptions and changes necessitated by brain injury.
Over the last decade with the aid of science and technology, we are more familiar with the human brain and its function than ever before. Development in neuroimaging techniques has greatly enhanced the scope and outcome of neurorehabilitation. Now, scientists are using technology with neurorehabilitation to provide cutting edge improvements to therapies for patients with nervous system issues. In particular, the use of robotics in neurorehabilitation is becoming more and more common. [4]
Virtual reality simulations and video games provide patients with an interactive way to explore and re-learn different aspects of their lives and environments while being observed within the safety of their treating therapists and physicians. These devices and simulations, along with other robotic technology, offer patients who have just had strokes, other brain or spinal cord injuries the option of training and physical therapy much sooner than might otherwise be possible, thus shortening the recovery period.
This article incorporates material from the Institut Guttmann, who consents publication licensed by the Free Documentation GNU/GFDL
Hemiparesis, or unilateral paresis, is weakness of one entire side of the body. Hemiplegia is, in its most severe form, complete paralysis of half of the body. Hemiparesis and hemiplegia can be caused by different medical conditions, including congenital causes, trauma, tumors, or stroke.
Neurology is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the nervous system, which comprises the brain, the spinal cord and the peripheral nerves. Neurological practice relies heavily on the field of neuroscience, the scientific study of the nervous system.
Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, patient education, physical intervention, rehabilitation, disease prevention, and health promotion. Physical therapists are known as physiotherapists in many countries.
Occupational therapists (OTs) are health care professionals specializing in occupational therapy and occupational science. OTs and occupational therapy assistants (OTAs) use scientific bases and a holistic perspective to promote a person's ability to fulfill their daily routines and roles. OTs have training in the physical, psychological, and social aspects of human functioning deriving from an education grounded in anatomical and physiological concepts, and psychological perspectives. They enable individuals across the lifespan by optimizing their abilities to perform activities that are meaningful to them ("occupations"). Human occupations include activities of daily living, work/vocation, play, education, leisure, rest and sleep, and social participation.
Spasticity is a feature of altered skeletal muscle performance with a combination of paralysis, increased tendon reflex activity, and hypertonia. It is also colloquially referred to as an unusual "tightness", stiffness, or "pull" of muscles.
Rehabilitation of sensory and cognitive function typically involves methods for retraining neural pathways or training new neural pathways to regain or improve neurocognitive functioning that have been diminished by disease or trauma. The main objective outcome for rehabilitation is to assist in regaining physical abilities and improving performance. Three common neuropsychological problems treatable with rehabilitation are attention deficit/hyperactivity disorder (ADHD), concussion, and spinal cord injury. Rehabilitation research and practices are a fertile area for clinical neuropsychologists, rehabilitation psychologists, and others.
Functional electrical stimulation (FES) is a technique that uses low-energy electrical pulses to artificially generate body movements in individuals who have been paralyzed due to injury to the central nervous system. More specifically, FES can be used to generate muscle contraction in otherwise paralyzed limbs to produce functions such as grasping, walking, bladder voiding and standing. This technology was originally used to develop neuroprostheses that were implemented to permanently substitute impaired functions in individuals with spinal cord injury (SCI), head injury, stroke and other neurological disorders. In other words, a person would use the device each time he or she wanted to generate a desired function. FES is sometimes also referred to as neuromuscular electrical stimulation (NMES).
The primary goals of stroke management are to reduce brain injury and promote maximum patient recovery. Rapid detection and appropriate emergency medical care are essential for optimizing health outcomes. When available, patients are admitted to an acute stroke unit for treatment. These units specialize in providing medical and surgical care aimed at stabilizing the patient's medical status. Standardized assessments are also performed to aid in the development of an appropriate care plan. Current research suggests that stroke units may be effective in reducing in-hospital fatality rates and the length of hospital stays.
Physical medicine and rehabilitation, also known as physiatry, is a branch of medicine that aims to enhance and restore functional ability and quality of life to people with physical impairments or disabilities. This can include conditions such as spinal cord injuries, brain injuries, strokes, as well as pain or disability due to muscle, ligament or nerve damage. A physician having completed training in this field may be referred to as a physiatrist.
The Bobath concept is an approach to neurological rehabilitation that is applied in patient assessment and treatment. The goal of applying the Bobath concept is to promote motor learning for efficient motor control in various environments, thereby improving participation and function. This is done through specific patient handling skills to guide patients through the initiation and completing of intended tasks. This approach to neurological rehabilitation is multidisciplinary, primarily involving physiotherapists, occupational therapists, and speech and language therapists. In the United States, the Bobath concept is also known as 'neuro-developmental treatment' (NDT).
Gait training or gait rehabilitation is the act of learning how to walk, either as a child, or, more frequently, after sustaining an injury or disability. Normal human gait is a complex process, which happens due to co-ordinated movements of the whole of the body, requiring the whole of Central Nervous System - the brain and spinal cord, to function properly. Any disease process affecting the brain, spinal cord, peripheral nerves emerging from them supplying the muscles, or the muscles itself can cause deviations of gait. The process of relearning how to walk is generally facilitated by Physiatrists or Rehabilitation medicine (PM&R) consultants, physical therapists or physiotherapists, along with occupational therapists and other allied specialists. The most common cause for gait impairment is due to an injury of one or both legs. Gait training is not simply re-educating a patient on how to walk, but also includes an initial assessment of their gait cycle - Gait analysis, creation of a plan to address the problem, as well as teaching the patient on how to walk on different surfaces. Assistive devices and splints (orthosis) are often used in gait training, especially with those who have had surgery or an injury on their legs, but also with those who have balance or strength impairments as well.
Aquatic therapy refers to treatments and exercises performed in water for relaxation, fitness, physical rehabilitation, and other therapeutic benefit. Typically a qualified aquatic therapist gives constant attendance to a person receiving treatment in a heated therapy pool. Aquatic therapy techniques include Ai Chi, Aqua Running, Bad Ragaz Ring Method, Burdenko Method, Halliwick, Watsu, and other aquatic bodywork forms. Therapeutic applications include neurological disorders, spine pain, musculoskeletal pain, postoperative orthopedic rehabilitation, pediatric disabilities, and pressure ulcers.
The Shepherd Center is a private, non-profit hospital in Atlanta, Georgia. Founded in 1975, the hospital focuses on rehabilitation for people with spinal cord injury and disease, acquired brain injury, multiple sclerosis, chronic pain and other neuromuscular problems.
MedStar National Rehabilitation Network is located in Washington, D.C., and specializes in treating persons with physical disabilities. The National Rehabilitation Hospital was founded in 1986 by Edward A. Eckenhoff, and is a member of the MedStar Health system, the Washington, D.C.-Baltimore region's largest non-profit healthcare organization.
Swami Vivekanand National Institute of Rehabilitation Training and Research is an autonomous institute functioning under the Ministry of Social Justice and Empowerment of India. It is located in Olatpur, 30 km from Cuttack.
Magee Rehabilitation Hospital, part of Jefferson Health, founded in 1958, is a 96-bed specialty medical rehabilitation hospital providing physical and cognitive rehabilitation services. Magee's flagship facility is located in Center City Philadelphia. In addition to the main campus that offers comprehensive services for spinal cord injury, brain injury, stroke, orthopaedic replacement, amputation, pain management and work injury, Magee provides an expanding outpatient network serving the surrounding communities. In 1985, Magee's brain injury rehabilitation program became the first in the nation to be accredited by the Commission on the Accreditation of Rehabilitation Facilities. Magee partnered with Jefferson Hospital to create one of the nation's 14 federally designated centers for spinal cord injury rehabilitation. Magee has been rated one of America's leading rehabilitation hospitals by U.S. News & World Report. Magee provides treatment to more than 5,000 individuals annually. Magee is authorized to treat wounded military personnel returning from war. Magee is not an Obligated Group Affiliate.
The Wolfson Neurorehabilitation Centre, also better known simply as The Wolfson, was a specialist neurorehabilitation centre based in Wimbledon, south west London. The services provided at the centre are now provided at St George's Hospital in Tooting and Queen Mary's Hospital in Roehampton.
A gait trainer is a wheeled device that assists a person who is unable to walk independently to learn or relearn to walk safely and efficiently as part of gait training. Gait trainers are intended for children or adults with physical disabilities, to provide the opportunity to improve walking ability. A gait trainer offers both unweighting support and postural alignment to enable gait practice. It functions as a support walker and provides more assistance for balance and weight-bearing, than does a traditional rollator walker, or a walker with platform attachments. It also provides opportunities to stand and to bear weight in a safe, supported position.
Burke Rehabilitation Hospital is a non-profit, 150-bed acute rehabilitation hospital located in White Plains, New York. It is the only hospital in Westchester County entirely dedicated to rehabilitation medicine. Opening in 1915, Burke has been involved in medical rehabilitation for over one hundred years. As of January 2016, Burke is a member of the Montefiore Health System, Inc.
When treating a person with a spinal cord injury, repairing the damage created by injury is the ultimate goal. By using a variety of treatments, greater improvements are achieved, and, therefore, treatment should not be limited to one method. Furthermore, increasing activity will increase his/her chances of recovery.
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